桂枝茯苓丸加减对急性缺血性脑卒中患者侧支循环建立及近期预后的影响

Influence of Jiajian Guizhi Fuling Pills on Collateral Circulation and Recent Prognosis of Patients with Acute Ischemic Stroke

目的观察桂枝茯苓丸加减对急性缺血性卒中(AIS)患者侧支循环建立及近期预后的影响。方法选取AIS患者104例,按照随机数字表法分为两组,对照组52例应用标准化治疗,治疗组52例在标准化治疗基础上联用桂枝茯苓丸治疗,疗程14d。治疗前后评价美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、蒙特利尔认知评估量表(MoCA)评分,采用弥散加权成像技术(DWI)测量梗死灶体积(VDWI)和缺血半暗带体积(VIP),测定梗死区域及缺血半暗带相对脑血流量(rCBF)。随访30 d采用改良Rankin量表(mRS)评估近期预后。结果两组患者治疗后NIHSS评分均低于治疗前,BI和MoCA评分高于治疗前,且治疗组NIHSS评分低于对照组而BI、MoCA评分高于对照组,差异具有统计学意义(均P<0.05)。两组患者治疗后VDWI、VIP均低于治疗前,且治疗组低于对照组;梗死区域及缺血半暗带rCBF均高于治疗前,且治疗组高于对照组,差异具有统计学意义(均P<0.05)。治疗组侧支循环改善率和预后良好率(mRS<2分)分别为71.15%、65.38%,高于对照组的55.77%、50.00%(P<0.05)。结论桂枝茯苓丸加减联合标准化治疗AIS疗效显著,能够促进侧支循环建立、改善脑血流灌注,促进神经功能及生活活动能力的改善,保护认知功能,改善近期临床预后。

Objective:To explore the influence of Jiajian Guizhi Fuling Pills on collateral circulation and recent prognosis of patients with acute ischemic stroke(AIS).Methods A total of 104 patients with AIS were enrolled and divided into two groups according to the random number table.Method:the control group(n=52)received standardized treatment,the treatment group(n=52)received Jiajian Guizhi Fuling Pills on the basis of standardized treatment.The course of treatment was 14 days.The National Institutes of Health Stroke Scale(NIHSS),Barthel Index(BI),Montreal Cognitive Assessment Scale(MoCA)scores were evaluated before and after treatment.The infarct volume under diffusion weighted imaging(DWI)sequence(VDWI),ischemic penumbra volume(VIP),relative cerebral blood flow(rCBF)of infarct area and ischemic penumbra were measured.The shortterm prognosis was evaluated by modified Rankin scale(mRS)after 30 days of follow-up.Results:After treatment,the NIHSS scores of the two groups were lower than before treatment,the BI and MoCA scores were higher than before treatment,and the NIHSS scores of the treatment group were lower than the control group,the BI and MoCA scores were higher than the control group,the differences were statistically significant(P<0.05).After treatment,the VDWI and VIP of the two groups were lower than before treatment,and the treatment group were lower than the control group;the rCBF of infarct area and ischemic penumbra were higher than before treatment,and the treatment group were higher than the control group,the differences were statistically significant(P<0.05).The collateral circulation improvement rate and good prognosis rate(mRS<2)in the treatment group were 71.15%and65.38%,respectively,which were higher than 55.77%and 50.00%in the control group(P<0.05).Conclusion:Jiajian Guizhi Fuling Pills combined with standardized treatment is effective for patients with AIS,which can promote the establishment of collateral circulation,improve cerebral blood flow perfusion,promote the improvement of neurologic function and life activity ability,protect cognitive function,and improve the recent clinical prognosis。